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CANCER PROGRAM
Of Southeastern Med
 presents the
2007 Cancer Program Annual Report
with Statistical Data from 2006

Southeastern Med
1341 Clark Street
Cambridge, Ohio 43725

Southeastern Med

Cancer Committee

2006
 

Michael Sarap, MD                                   James W. Keller, MD

Chairman, Surgery                                    President & CEO/CMO

Clifford Maximo, MD                                 Becky Wheeler, CTR

Urology                                               Cancer Registry

Andrew Eddy, MD                                    Bonnie Burns

Vice President Medical Affairs                       ACS Cancer Control Specialist

Charles Muchnok, MD                                Kelli Wehr

Radiology & Nuclear Medicine                        Radiation Therapist

Cambridge Regional Cancer

Eyad Mahayri, MD                                   Center

Internal Medicine
 

Robert L. Chess, MD                                 Gail Sims, LPN, MT

Pathology & Clinical Pathology                        Nursing

Srini Vasan, MD                                      Leigh Anne Hehr

Radiation Oncology                                   ACS Colorectal Initiative

Nik Shah, MD                                        David Finn, R.Ph

Oncology/Hematology                                             Director Pharmacy

Renee Shalosky, RN, MSN, CPHQ
Director Quality Improvement

Sandy Black, RN, OCN

Nursing

Bev Peeper, RNC

Nursing

Nancy Neff, LSW, BSW, CCM

Quality Care Management

INTRODUCTON

The goal of the Southeastern Med cancer program is to provide quality care for cancer patients and their families as well as decrease the morbidity and mortality of patients with cancer. Such a goal cannot be met by any one individual, but through the collective efforts of many. Those actively involved in helping our cancer patients, include physicians, nurses, social workers, hospital support staff, management, hospital volunteers, clergy and community support groups including the American Cancer Society and Hospice of Guernsey. Through the combined work of these groups, the care and support of cancer patients and their families is improved.

The Southeastern Med Cancer Program is approved by the American College of Surgeons, Commission on Cancer, and is committed to the commission’s standards of performance, improvement, outcome measurements, cost-effectiveness and collaboration with physicians and other health care service agencies.

This annual report summarizes the Cancer Program’s experience with the statistical data for 2006.

Southeastern Ohio Regional Medical Center is pleased to present our 2007 Annual Report.

REPORT FROM THE CHAIRMAN…..

       Southeastern Ohio Regional Medical Center would like to share with you it’s Cancer Program’s Annual report for the calendar year of 2006. Our Cancer Program has had a busy and productive year in 2006. Our commitment to continually improve the quality of care for the cancer patient was demonstrated by our continued achievements.

v      Implemented LAB OUTREACH program with the Cambridge Regional Cancer Center, providing outpatient phlebotomy services for oncology patients.

v      Implemented chemotherapy protocols for several chemo medications after approved by Pharmacy Committee.

v      Initiated phone contacts within 24 hours of therapy for ASA patients to assess tolerance and side effects of treatment.

v      Collaboration with Southeastern Med and American Cancer Society continued to provide a Patient Navigator Program to help patients, families, & caregivers navigate the systems needed during the cancer journey serving 45 patients during 2006.

v      Continued the “Tar Wars” tobacco education program in the schools, making 29 presentations and reaching 700 children.

v      Collaborated with American Cancer Society and the Ohio Department of Health to hold the Second Colon Cancer Summit on October 11^th, 2006. Efforts revealed: Increased colorectal screening by 34% in one year, 10% increase in polyp removal & total # of colorectal cancer diagnosis has risen 33% since formation of the team.

v      Held three Look Good Feel Better classes reaching 15 participants.

v      Continued to offer Freshstart Smoking Cessation classes.

v      Distributed colon-screening kits at numerous health fairs as well as Byesville Pharmacy & Northstar Pharmacy.

v      Participated in the Older Adult Health Fair offering skin cancer screening and oral screening.

v      Collaborated with ACS, Cambridge Regional Cancer Center, and Guernsey County Cancer Society to offer Cancer Survivors Day Celebration on June 4^th with 78 cancer survivors attending.

v      Participated in the annual Children’s Health Fair offering tobacco education.

v      Participated in Relay For Life on June 23^rd & 24^th .

v      Provided a community educational luncheon “Advances in Breast Cancer Prevention, Detection & Diagnostic Procedures” with speakers Dr. Sarap & Dr. Eke with over 60 in attendance on October 27, 2006.

v     Coordinated a program with Genesis Cancer Services called “Reducing Cervical Cancer in Appalachia Ohio” on November 7^th, 2006 with 30 in attendance.

v     Provided Pain Management Breakfast In-service for physicians on September 20^th, 2006.

v     Provided professional education in-service on Chemo Induced Nausea & Vomiting for physicians and other healthcare professionals on March 22, 2006.

v     Offered “Cancer & Nutrition” presentation on March 28, 2006 in association with churches.

v     Piloted “Blue Sticky Note” Project with physicians to remind them to discuss colon cancer with their patients.

v     Colorectal Task Force received grants from the American Cancer Society & Kiwanis Foundation to continue educational efforts.

The Cancer Committee continued our commitment to excellence in Oncology care emphasizing the involvement of the community, and the primary care physicians on the care of the patient with cancer, as well as making available the most advance treatment of our patients.

It is with great pleasure that we present the Southeastern Med 2006 Cancer Program Annual Report.

Michael Sarap, MD
Cancer Committee
Chairman

CANCER REGISTRY

The Cancer Registry is the cancer data center for Southeastern Med. The mission of the Cancer Registry is to encourage systematic lifetime re-examination of all cancer patients and to provide statistics on collected data to staff physicians for research and educational evaluation. The primary goal of the Registry is to monitor all types of cancer diagnosed and/or treated at Southeastern Med. The maintenance and collection of accurate data is also a useful tool for administrative planning of hospital resources and staff. Established in January, 1985 the data base is maintained by a Certified Cancer Registrar who collects cancer management data and annually follows every living patient in the registry. She is not only responsible for data collection but other activities which include planning all meetings with the Cancer Committee; planning and recording necessary documentation of monthly Cancer Conferences; preparing all Patient Care Evaluation Studies.

The Cancer Registry uses a data system called Precis Hospital which is designed to collect, manage, and analyze data on patients with all types of cancer. Included in the database are every inpatient and outpatient diagnosed and/or treated at Southeastern Med. The data is then reported to national, and state agencies, who will help determine the most successful treatment options available to cancer patients in the future. These agencies are:

The Ohio Cancer Incidence Surveillance System (OCISS)

The National Cancer Data Base

Much of the aggregate information is published in local, state and national reports, such as the American Cancer Society Facts and Figures.

The Commission on Cancer designs Patient Care Evaluations (PCEs) to be completed by the Cancer Registrar and a member of the Cancer Committee. Patient Care Evaluation studies are nationwide studies of malignant diseases that are designed to describe the practice of medicine at the community level and to provide management and patient survival information.

It is the purpose of the registry to provide information to interested qualified parties as part of the service of the department. Requests should be directed to Becky Wheeler, CTR from 6 a.m. to 2:30 p.m. daily.

Annual lifetime follow-up of former patients is a very important part of the program. This is accomplished through letters to the attending physician or by letters or phone calls to patients and/or family members. The registry serves as a reminder to former patients to continue their follow-up exams with a physician. Currently approximately 1062 patients are in active follow-up maintaining 95% follow-up rate.

A total of 226 new cases were accessioned into the registry at Southeastern Med during 2006. A total of 4288 new cancer cases have been entered into the registry since January 1, 1985.

If you have questions about the Cancer Registry, need referral information or have questions about a cancer diagnosis, please feel free to call Becky Wheeler, CTR, Cancer Registrar at (740) 439-8156.

CANCER CONFERENCE

The Cancer Conference (Tumor Board Conference) is a multidisciplinary conference held monthly at Southeastern Med. This conference provides a forum for coordinating cancer care. The meeting serves to improve patient care by providing educational credits to all physicians, as well as other health care professionals attending the conference. Cancer Conferences are arranged and documented by the Cancer Registry staff and are scheduled the second Thursday of each month in the North Tower Conference Room.

Total number on conference in 2006                                 12

Total number of cases presented                              79

Total number of prospective cases presented           71 (90%)

The Mid-Ohio Valley continuing education designates our Cancer Conferences for one (1) credit hour in Category 1 for Physician Recognition Aware of the American Medical Association.

SUMMARY OF 2006 CANCER CASES

Incidence

According the Ohio Cancer Facts & Figures 2006 published by the American Cancer Society, the projected incidence for cancer in Ohio is 55,813 new cases. The registry staff abstracted a total of 226 cancer cases during 2006. Of those 207 were analytic and 19 were non-analytic cases, of which 13 were prostate cases diagnosed & treated in a physician office.

The four most commonly diagnosed cancer sites at Southeastern Med in 2006 were breast with 52 cases (25%), colon/rectum with 40 cases (19%), lung with 30 cases (14%), and prostate with 17 cases (8%). This is illustrated graphically below.

Note: An additional 13 cases of prostate cancer were diagnosed & treated in a physician

office and considered non-analytical and not included in this graph.

A comparison of the sites with the National and State statistics is shown below.

* Based on information from ACS Cancer Facts & Figures 2006.

Age

The incidence of cancer increases with age. In 2006, 207 (65%) of the cases diagnosed were between 60 and 89 years of age. Mean age was 66.2 years. A graph below illustrates aged distribution at diagnosis.

Sex

Males accounted for 83 cases (41%) and females accounted for 119 cases (59%) in 2006.

County at Diagnosis:

                As you can see from the graph below, 82% of all cases diagnosed at Southeastern Med reside in Guernsey County. 8% of the patients reside in Noble County and several other surrounding counties make up the rest of the cases.

Stage at Diagnosis

Referring to the Table below, it can be seen that 21 cases (10%) were diagnosed in Stage 0 ( In Situ),  59 cases (29%) were diagnosed in Stage I, 39 cases (19%) were diagnosed in Stage II, 26 cases (13%) diagnosed in Stage III and 27 cases (13%) in stage IV. 35 cases (16%) were either unknown or unstaged. 

PRIMARY SITE ANALYSIS

COLORECTAL CANCER

Michael Sarap, M.D.

            Screening tests offer a powerful opportunity for the prevention, early detection, and successful treatment of colorectal cancers. Yet, fewer than 45% of Americans 50 and older have had a sigmoidoscopy or colonoscopy in the past five years. While people cannot change their genetic makeup or family health history, most people can reduce their risk of colorectal cancer by following screening guidelines; eating a healthy, low-fat diet; and increasing their level of physical activity.

            Nationally, an estimated 106,680 colon and 41,930 rectal cancer cases occurred in 2006. Colorectal cancer is the third most common cancer both in men and women. The incidence rate declined marginally by almost 2% per year during the period 1998 – 2002. Research suggests that these declines may be in part due to increased screening and polyp removal, preventing progression of polyps to invasive cancers.

            The risk of developing colorectal cancer increases with age. In Ohio, between 1999 and 2003, approximately 93% of individuals who developed colorectal cancer were 50 and over. Currently, a man living in the United States has a 1 in 24 lifetime risk of developing invasive colorectal cancer, and a woman has a 1 in 29 lifetime risk of developing invasive colorectal cancer.

            An estimated 55,170 colorectal cancer deaths occurred in 2006 nationally, accounting for about 10% of cancer deaths. The mortality rate continued to decline for both men and women over the past two decades, at an average of 1.8% per year.

            Surgery is the most common form of treatment for colorectal cancer. For cancers that have not spread, it is frequently a cure. Chemotherapy or chemotherapy plus radiation is given before or after surgery to most patients whose cancer has deeply penetrated the bowel wall or has spread to the lymph nodes. A permanent colostomy (creation of an abdominal opening for elimination of body wastes) is very rarely needed for colon cancer and is infrequently required for rectal cancer.         

            At Southeastern Med most new colorectal cancer cases are discussed at a multidisciplinary cancer conference to assure there is a consensus amongst caregivers in regard to the treatment plan.

            Following you will see a breakdown of the data for colorectal cancer diagnosed at Southeastern Med from 2002 – 2006. This includes case distribution by year, age & sex distribution, class of case, county at diagnosis, stage at diagnosis, first course of treatment, and observed survival rate by stage.

CASE DISTRIBUTION BY YEAR

            Between 2002 and 2006 there were 154 new cases of colorectal cancer diagnosed at Southeastern Med. A graph below shows the breakdown by year.

AGE DISTRIBUTION

The total number of Southeastern Med colorectal cancer cases between 2002 and 2006 is 154. The age distribution is listed below.

SEX DISTRIBUTION

Of the 154 cases of colorectal cancer diagnosed between 2002 and 2006, 47.68% were female and 52.32% were male.

CLASS OF CASE

Class of case tells us where the patient was diagnosed and treated. Between 2002 and 2006 we found that 95% of the colorectal cancer patients were diagnosed and treated here at Southeastern Med. We found that 3% were diagnosed here and treated elsewhere and 2% were diagnosed elsewhere and first course of treatment performed at Southeastern Med.  Thanks to our excellent physicians and treatment center, patients can be treated here at home.

COUNTY AT DIAGNOSIS

                Below is a graph, which shows county at diagnosis for our colorectal cancer patients, found between 2002 and 2006. As you can see 79% of our colorectal cancer patients reside in Guernsey County.

STAGE AT DIAGNOSIS

Nearly all colorectal cancers can be treated successfully if detected early. As you can see in the graph below, 27% of our colorectal cancer cases were found in early stages (Stage 0 In situ & Stage I). Only 14% were found in Stage IV (metastatic disease).

FIRST COURSE OF TREATMENT

          Below you will see the graph of First Course of Treatment for combined stages with comparison of Southeastern Med to NCDB (National Cancer Data Base).

OBSERVED SURVIVAL BY BEST STAGE

            The graph below shows the observed survival for colorectal cancer cases diagnosed at Southeastern Med between 1996 and 2006 and comparison five-year national survival rate.                                                                                                           

CONCLUSION

            The five-year relative survival rate for patients with colorectal cancer is 64%. When colorectal cancers are detected at an early (local) stage, the five-year relative survival rate is 90%; however; nationally, only 39% of colorectal cancers are diagnosed at a local stage. After the cancer has spread regionally to involve adjacent organs or lymph nodes, the survival rate drops to 68%; and for persons with distant metastases, the survival rate is only 10%.

COMMUNITY COLORECTAL CANCER SCREENING

What Have We Accomplished…..

Michael D. Sarap M.D., F.A.C.S., Becky Wheeler C.T.R.

                Colorectal cancer is the second leading cause of cancer death among Americans. There are 150,000 new cases and 57 thousand deaths per year. The lifetime risk of developing colorectal cancer is 5-6% and the risk can rise to 20-25% with family history or predisposing factors. Periodic screening colonoscopy in the appropriate population can prevent 75-90% of cases.

Screening tests for colorectal cancer have been clearly proven to decrease the incidence of the disease and also facilitate the diagnosis at earlier stages.  It is also well documented that the rates of screening in the appropriate at-risk population remain below expected levels. Only 20 states mandate that insurance companies cover the cost of screening colonoscopies. Even those individuals whose insurance will cover the testing fail to take advantage of these potentially life-saving exams.

  The Ohio Cancer Incidence Surveillance System administered by the Ohio Department of Health identified several counties in Ohio that showed higher percentages of late stage diagnosis of colon and rectal cancer from data collected during 1999-2003. The ODH and the American Cancer Society met with taskforces from each of these 23 counties in early 2005 to investigate techniques that might increase screening and earlier diagnoses in their communities. Each county taskforce would then go on to address the problem in the most efficient manner for their individual communities. See figure 1.

Figure 1 Percent Late Stage

The Guernsey County Colorectal Taskforce was formed and began work early in 2006. The mission was to raise awareness of the significance of colorectal cancer and to enhance early detection by disseminating information and mobilizing community resources. The vision was to decrease colorectal cancer incidence and mortality in Southeastern Ohio and improve the quality of life for all colorectal cancer survivors. A slogan was developed entitled “Face the Bear Facts: Colon Screenings Save Lives”. Team members included the Cancer Registrar and Cancer Program Administrator, nurses from various hospital departments, representatives from the American Cancer Society and local Health Department, local physicians and surgeons, a marketing department specialist and a cancer survivor. The taskforce included the CEO and the VP of Medical Affairs of the local hospital, Southeastern Med, signifying the importance placed on the initiative by local health care providers. Two representatives of National City Bank served on the taskforce for community support.

Guernsey County geographically sits on the edge of Appalachia. See figure 2. Six of the counties in our region have no hospitals. Southeastern Med has 90 acute care beds, 75 physicians on staff and has strived to be a regional center in this very rural area. Our Cancer Program has been accredited since 1991. Three general surgeons cover  oncology, vascular and thoracic services and also provide all endoscopic support for the hospital.

Figure 2

The colorectal initiative received excellent community support in the form of various grants and donated time and services. Grants and donations were obtained from the American Cancer Society, Wal-Mart, the Kiwanis Foundation, National City Bank, Ohio Department of Health and The OSU Department of Pathology. Multiple physicians donated time and services. A private video company produced an award winning educational video at no cost to the taskforce. 

The taskforce concentrated its efforts in three general areas. These were physician education, community education and concerted efforts to provide screening tests to the public in the form of free Hemawipe tests and reduced cost and no cost colonoscopies to those patients with financial difficulties. Primary care offices were visited and ACS screening guidelines were made available, posters and pamphlets were offered and the Blue Sticky Note Project (ODH involvement) was instituted to encourage conversation about screening tests between physicians and patients. Community education efforts included four billboards, radio spots, direct postcard mailings to 10,500 households in five counties, and newspaper articles. The previously mentioned video documented the hospital CEO undergoing an actual colonoscopy.  National City Bank allowed displays in their bank lobbies, presentations were made to all local service clubs, brochures were sent with the Senior Citizen Center Meals on Wheels and a Theater ad reached 130,000 patrons in 12 months. In 2007 we placed informational brochures in the local newspapers of Guernsey County and several surrounding counties.

The multiple initiatives prompted nearly 400 calls to our cancer program administrator for more information, to acquire Hemawipes or to arrange an interview with our financial counselors for the reduced cost or free colonoscopy. Nearly 90 colonoscopies were carried out with most being totally free, including the physician, hospital and pathology fees.

The taskforce efforts resulted in a 22% increase in colonoscopies for 2007 and polyp detection increased by 63% since the beginning of the taskforce efforts. The total number of cases of colorectal cancer diagnosed rose 50% in one year (2005-27 cases, 2006-40). The 2007 total was 23 cases. More than double the previous number of Stage I cases were found in 2006. In the three years since inception of the taskforce the number of late stage cancers has fallen and Guernsey County is now in the best statistical category instead of the worst in the state of Ohio. See figures 3, 4 & 5.

Figure 3
 

Figure 4
 

Figure 5

During 2008 the initiatives have continued. The taskforce has just received notice of additional grant money from the American Cancer Society and has decided to use part of the funds to provide primary care physicians with a flash drive containing an educational presentation on colorectal cancer and the benefits of appropriate screening. Colonoscopy numbers continue to trend upward as do the numbers of polyps being removed in comparison to 2005 and before the colorectal cancer taskforce began its work.

Our efforts and results have been recognized at local, state and national gatherings. Our initiatives and data have been presented at the Commission on Cancer National Meeting, a Colon Cancer Conference at the CDC, the Community Cancer Control in Appalachia Conference, and at several state meetings. We have been invited to give testimony to the Ohio House and Senate Cancer Caucus in Spring 2008.

Clearly, in our small community there has been a definite improvement in awareness of colorectal cancer screening and real progress in decreasing late stage diagnoses. These improvements have been accomplished with minimal resources, without governmental funding and by fostering relationships with primary care providers and the American Cancer Society. Our hope and intent would be that our modest efforts could be expanded to state and national initiatives that would increase education to the public and to primary care physicians on the value of screening, mandate screening coverage by insurers and obtain funding to provide screening and diagnostic colonoscopies to those at-risk populations. Each of these initiatives would benefit the total population in preventing many colorectal cancer cases and limiting most to early stage and easily treated cancers.

DEFINITION OF TERMS

Analytic – A case that was either initially diagnosed or received all or part of the initial course of therapy at SEORMC.

Non-Analytic – A case diagnosed and treated prior to admission to SEORMC or, if no treatment was received, a case that was admitted more than four months after initial diagnosis. Cases that were initially diagnosed at autopsy are considered non-analytic as well.

Stage – The registry records stage using the SEER Site Specific System; in-situ, localized, regional, distant, or unstaged, as well as AJCC/TNNM Staging System: Tumor, Nodes and Metastasis.

Survival – Calculated from date of best confirmation of diagnosis to date of last contact for analytic cases only.

In-Situ – A tumor that fulfills all the microscopic criteria for malignancy except invasion.

Localized – A neoplasm that appears to be confined entirely to the organ of origin.

Regional – A tumor that has extended beyond the limits of the organ into: surrounding organs or tissue by direct extension or regional lymph nodes.

Distant – A tumor that has spread to parts of the body remote from the primary malignancy

Unknown – Information is not sufficient to assign a stage.

AJCC Staging – American Joint Commission on Cancer TNM Stage: T=Primary tumor; N=Regional lymph nodes; M=Distant Metastasis

NCDB – National Cancer Data Base

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